PROJECT SUMMARY Worldwide, unintended pregnancy and short pregnancy intervals contribute substantially to poor maternal and child health outcomes. Global family planning (FP) initiatives remain focused on promoting access to reproductive health services and uptake of modern methods of contraception, but efforts to understand why women choose to discontinue use have not been prioritized. Early contraceptive discontinuation, within 12 months of initiation, has been termed the ?leaking bucket? of contraceptive coverage and is a substantial driver of high unmet need for FP. Evidence suggests quality of facility-based FP care, method type, and experience of contraceptive side effects may contribute to early method discontinuation. Development of more effective programs to improve women's experiences and effective long-term use of contraception for women in need of FP will require deeper understanding of method dissatisfaction and discontinuation, relationships between experience of side effects and subsequent discontinuation, and standardized metrics for evaluating quality of service delivery. In this proposal, data from a prospective cohort study will be leveraged to evaluate the relationships between contraceptive side effects, dissatisfaction, and contraceptive discontinuation in a setting with high maternal mortality. The proposed project will utilize data from 1,254 newly initiating or continuing modern FP in Kenyan maternal and child health (MCH) clinics. Study data was captured through a novel mobile messaging platform, using tailored short message system (SMS) surveys. Surveys measure FP use, concerns, side effects, and satisfaction on a weekly basis. This prospective and dynamic approach to remotely collect data using the mobile platform will provide unique insights into contraceptive use. We propose the following aims: 1) to determine the relationship between quality of FP method counseling received at baseline and subsequent risk of method discontinuation, adjusting for method type; 2) to measure the time of onset of bleeding side effects (amenorrhea, spotting, heavier bleeding), and identify participant characteristics associated with method continuation among women who experience bleeding side effects; and 3) to measure prevalence and correlates of method dissatisfaction by 6 months, including method type, experience of side effects, age, pregnancy intention, and relationship status. Pilot data from this study will be used to inform the design of interventions to support method continuation for birth spacing and limiting, and improve maternal and child health outcomes.